#1791 Control Without Obsession

Summary

Juicebox Podcast: Type 1 Diabetes

Episode #1791 - "Control Without Obsession"

Host: Scott Benner
Guest: Jenny Smith (Certified Diabetes Educator, T1D for 37+ yrs)
Date: March 6, 2026

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Episode Overview

This episode centers on strategies for living well with Type 1 diabetes without falling into unhealthy obsessions—a conversation about progress, frustrations, and hope in the diabetes tech and care landscape. Host Scott Benner and CDE Jenny Smith candidly discuss new tech, ongoing pain points, and the importance of community and feedback. Listeners get a detailed, honest, and often humorous look at what’s working, what’s not, and what patients and caregivers truly want from diabetes management today.

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Key Discussion Points & Insights

1. Excitement About New Technology: The Twist Pump

• Jenny shares her enthusiasm for the new Twist hybrid closed-loop insulin pump ([03:23]).
  • Offers features many in the community have wanted: lower targets, more control, compatibility with multiple CGMs (currently Libre 3 Plus and Eversense 365; Dexcom possibly coming).
  • Built with input from the DIY “Loop” algorithm community.

  "I really am... It's a step in the right direction... targets that are lower... the way the algorithm works... with control knobs you can turn." — Jenny [03:30]

• Algorithm currently temp basal–only (does not yet incorporate auto-bolus), but targets can go as low as 87 mg/dL ([05:27]).
• Apple Watch compatibility: major benefit for discretion, particularly for children in school ([06:57]).

2. Interoperability and Frustrations with Slow Progress

• Discussion about barriers to integrating new features and expanding device compatibility ([04:28], [11:09]).

  "If there weren't halting factors in getting adjustments to our technology... it's slow. That is a common thread." — Jenny [11:20]

• DIY community and patient-driven innovation outpaces commercial product updates.
• Desire for end-user (patient) input in development and regulatory panels ([13:03]).

3. The Value and Limits of Provider Lists

• Scott introduces the redesigned “Juicebox Docs” repository, now searchable for patient-friendly and DIY-friendly endocrinologists ([07:39]).
  • Reflects the need to find providers supportive of individualized and loop-based management.
• Jenny: Those willing to work with DIYers tend to think outside the box and individualize care ([09:43]).

4. Pain Points in Diabetes Tech

a. Settings/Algorithm Backups ([23:05])

• Major frustration: adaptive algorithms (e.g., Omnipod 5, Medtronic) do not back up customization/settings to the cloud.

  "If I drop my phone in the toilet, they're all gone... Have you heard of the Internet? Do you know what the cloud is?" — Scott [24:26]

• HIPAA and technical excuses flagged, but both hosts insist on the necessity and feasibility, even with anonymization.

b. Lack of Simple, User-Requested Features

• Example: Delta (glucose change) display on CGMs, a longstanding user request ignored by companies ([18:00]).

  "The whole community wants that thing—to show delta 100%... It's the reason that it's in the DIY stuff." — Jenny [18:58]

c. Device Discontinuation Dilemmas

• Frustration over ending support for devices that work reliably for some (e.g., Dexcom G6), forcing users to switch ([31:28],[32:35]).
  • Companies face resource limitations and have to shift focus for progress, likened to discontinuing older car models ([33:08]).

5. Balancing Critique with Gratitude

• Both hosts repeatedly emphasize how far technology has come, even as they critique shortcomings.

  "Thank God... they’re doing this stuff... if they weren't, you'd get what you get and that would be it." — Scott [35:45]

• Acknowledge device shortfalls but remain positive about advances’ impact on health, quality of life ([28:03], [31:00]).

6. Hope for the Future: Stem Cell Therapy and AI

• Jenny expresses hope for emerging implantable cell therapies (beta-cell encapsulation, immune system breakthroughs) to reduce burdensome daily management ([38:20]).
  • Recognizes therapy advances over the elusive "cure," as well as the power of AI to accelerate research ([41:49]).

7. The Cost of Wasted Time: Importance of Practical Knowledge

• Addressing the emotional cost of wasted years due to poor diabetes education ([42:54]).

  "The greatest sin is to waste time. Life is just too short... I've had diabetes for 10 years, no one told me to prebolus..." — Scott [43:15]

• Urges companies and HCPs to “feed the soul” with incremental progress, not vague promises.

8. Provider Knowledge Gaps: The Need for Better Clinical Education

• Discussion of how some endocrinologists lack practical, lived understanding of T1D ([55:24]).

  "I just spoke to an endo, and I feel like I know way more about managing type 1 diabetes than this doctor does. Is that really possible, or am I a narcissist?" — Scott [55:24]

• Jenny retells alarming stories of poor guidance (e.g., family denied a glucagon prescription) ([56:07-58:19]).
• Sincere call for humility and knowledge sharing among clinicians:

  "Educators and endos should be doing the same as car companies—looking at what makes patients successful." — Jenny [50:45]

9. Community, Shared Learning & the Power of Conversation

• Both reflect on the power of their ongoing partnership and the Juicebox Podcast’s impact. Sharing successes helps others aim higher, even if not everyone achieves the same outcomes ([53:23]).

  "If this idiot’s doing it, maybe I could figure it out." — Scott [53:57]

• Podcast and community provide a scalable way for knowledge and hope to reach far beyond what any single provider can handle ([50:34]).

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Notable Quotes & Moments

• Jenny on user-driven tech and lower targets ([05:27]):

  "The targets go as low as 87... for people pregnant or planning pregnancy, now the target is already there."

• Scott on device interoperability ([09:25]):

  "We started this list as doctors who wouldn't laugh at you if you said, ‘I listened to a podcast...’"

• On lack of true end-user input in product design ([13:02]):

  "Was anybody with diabetes on this board of configuration—who thought this was a good idea?" — Jenny

• On companies’ resistance or sluggishness ([20:30]):

  "Please, can you add delta? People are asking for delta... it's on the list...'What list?'" — Scott & Jenny

• On setting expectations for progress ([34:34]):

  "Arden's had diabetes... it has always gotten better. Two steps forward, one step back... farther ahead than we were." — Scott

• On emotional impact of poor clinical advice ([57:19]):

  "Told them this... a pediatric endo told this family, 'you don't need glucagon.'" — Jenny

• On hope vs. false promises ([41:10]):

  "I'm more hopeful for therapies that actually navigate an issue, not technically be solved, but there's an outside way..." — Jenny

• On sharing therapy and management insights ([48:59]):

  "The descriptive way you explain something, it helps me talk through things in a different manner with people..." — Jenny

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Timestamps – Segment Guide

• 03:23 | Jenny’s excitement about the Twist pump
• 07:39 | Juicebox Docs directory & finding out-of-the-box clinicians
• 11:09 | Frustrations with slow tech progress and regulatory drag
• 18:00 | The ignored delta request & user-driven CGM features
• 23:05 | Algorithm backups missing—device pain points
• 31:28–34:34 | G6 discontinuation, progress vs. user needs
• 38:20 | Hope in cell therapy and AI-fueled research
• 42:54 | Wasted time, pre-bolusing, and the importance of knowledge transfer
• 50:30 | Community scaling, educator/endo learning from patient experiences
• 55:24 | Do patients sometimes know more practical management than doctors?
• 56:07-58:19 | Alarming provider stories (e.g., no glucagon prescribed)
• 64:56 | Directory flag for “provider with type 1” badge

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Overall Tone & Takeaways

• Candid, honest, and humorous, punctuated by both optimism and frustration.
• The hosts celebrate clear wins and progress but refuse to paper over real shortcomings in tech, education, and clinical care.
• There is a strong call for industry and clinicians to prioritize actionable community feedback and patient experience.
• The conversation models the kind of two-way learning that is often missing in clinical environments.
• Resonant themes: community wisdom, empowering patients, patient-driven progress, hope for the future without naivete about challenges.

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For Listeners: Actionable Summary

• If you want clinicians who “get it,” use resource lists like Juicebox Docs and seek those open to DIY/loop approaches.
• Advocate for feature requests, both to tech companies and in your clinical care. Your voice matters.
• Keep perspective: Progress is uneven; not every product or provider will be a perfect fit—stay flexible and engaged.
• Share your struggles & wins: Community learning can shorten the path for someone else.
• Don’t accept poor care: Seek out those with humility, curiosity, and willingness to listen and learn.

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(End of summary)

Transcript

[A]

Hello friends and welcome back to another episode of the Juice Box Podcast. All right, Jennifer, here it is. We're moving. I have intentionally wound Jenny up prior to our conversation and then I'm just going to ask her one simple question. We're going to talk. How would you like to share a type 1 diabetes getaway like no other? Join me on Juice Cruise 2026. You may be asking, what is Juice Cruise? It's a week long cruise designed specifically for people and families living with type 1 diabetes. It's not just a vacation, it's a chance to relax, connect and feel understood in a way that is hard to find elsewhere. We're going to sail out of Miami and the cruise includes stops in Cococay, San Juan, St. Kitts and Nevis aboard the stunning Celebrity Beyond. This ship is chosen for its comfort, accessibility and exceptional amenities. You're going to enjoy a welcoming environment surrounded by others who get life with type 1 diabetes. I'm going to host diabetes focused conversations and meetups on the days at sea. There's thoughtfully designed spaces, incredible dining and modern amenities all throughout the Celebrity Beyond. Your kids can be supervised and there's teen programs so everyone gets time to recharge, not just the kids going on vacation. But maybe you get to kick back a little bit too. There's going to be zero judgment, real connections and a whole lot of sun and fun on Juice Cruise 2026. Please come with me. You're going to have a terrific time. You can learn more or set up your deposit@juicebox podcast.com juicecruise nothing you hear on the Juice Box Podcast should be considered advice, medical or otherwise. Always consult a physician before making any changes to your healthcare plan. This episode is sponsored by the TandemMobi system, which is powered by Tandem's newest algorithm, Control IQ technology. Tandem mobi has a predictive algorithm that helps prevent highs and lows and is now available for ages 2 and up. Learn more and get started today at tandemdiabetes.com Juicebox Today's episode is also sponsored by usmed.com Juicebox you can get your diabetes supplies from the same place that we do and I'm talking about Dexcom Libre, Omnipod, Tandem and so much more. Usmed.com juicebox or call 888-721-1514. The podcast is also sponsored today by the Eversense 365 the One Year Ware CGM. That's one insertion a year. That's it. And here's a little bonus for you. How about there's no limit on how many friends and family you can share your data with with the Ever since now app. No limits. Ever since. All right, Jennifer, here it is. We're moving. I have intentionally wound Jenny up prior to our conversation, and then I'm just going to ask her one simple question. We're going to talk about what's been bothering you around diabetes. Anything. What can we chat about today? We need a break from the bolus four.

[B]

Yeah, no, that's great. Bothering. Oh, my gosh.

[A]

Excited about. Bothered by something you wish would change. Go ahead, Jenny, be the king of the diabetes world.

[B]

No, I can say, well, one thing as a starting on like a positive, I can say that I'm really excited about Twist.

[A]

Okay, there you go.

[B]

I really am. I think it's a. A step in the right direction in terms of what's being brought to the population of people with diabetes. It offers a lot more features that a lot of people are looking for, like targets that are lower. The way that the algorithm works, the fact that you've got control knobs that you have a chance to turn, you know, with the DIY community as the initial piece to building the loop tide Pool loop within the Twist pump, it's got a solid foundation to it. And it was built by people like the base of it is built by people who knew that there could be something different. So if I'm excited about something, that is it. I'm also excited that they chose to go with different CGMs.

[A]

Yeah. Which ones are they available with now?

[B]

So the Libre 3 Plus and then the Eversense 365.

[A]

Okay. Do you think Dexcom will jump on? Do you think?

[B]

You know, I. I don't know. I've asked and I expect that it's in the pipeline just in terms of interoperability. Right. All of the systems are hoping at some point to have a little bit more pick and choose person to person, which I think is valid given that some people can use some sensors, some people can't. Right, Right.

[A]

I'll have an opportunity today to mention it to Dexcom, so I will.

[B]

Oh, yeah, yeah. I. I think it's a. I just. In general, I really like. I like the places that the company looks like it's moving as you know, where they're starting is a good. It's a good platform as long as they continue to get coverage and pick up speed.

[A]

So is the current build a basal adjustment for higher blood sugars?

[B]

It is, it is. So it's only the. For those who understand loop to Begin with. It's really only temp Basil strategy. It doesn't yet incorporate auto bolus strategy.

[A]

Okay.

[B]

But again the targets go as low as 87.

[A]

Yeah.

[B]

Comparative to the other systems that are currently on the approved list. And that brings in a whole nother group of people who maybe especially the population I heavily work with in pregnancy or preconception planning. It's like, well, the systems can kind of get me down but they never really get me into that target that I'm looking for. So we end up having to do a little bit of like work around the edges to get that. And with this system the target is already there. And I think it's a lovely thing.

[A]

Yeah. Targeting super. I think super important. I hope this is a good example. Arden's using Trio and she's very consistently recently been using her GLP medication.

[B]

Mm.

[A]

Her target during the day is 80. During the night I move it up to 90. And that keeps her from getting low overnight. Right. The last four days she had a kind of a stomach issue. She. She did not take her GLP when she should have and now we're three or four days past the week long injection. And if I don't move the overnight target from 90 to 80, she'll sit at 120 overnight.

[B]

Yeah.

[A]

Just like that. And. But if I put her to 80 then it'll grow. It somehow pulls her below 100. I don't pretend to understand the whole thing. I just know that that's how it works. Also I'd like to say Twist is a sponsor. I didn't know Jenny was going to say that but twist with two eyes.com juicebox to learn more. Thanks Jenny. I didn't realize that was going to happen.

[B]

No, no, absolutely. Because that is. I also have a really nice in my area here. I a couple months ago got a chance to meet with the clinical and just sales representatives. Just a really nice support group. All the information that you could possibly want and everything. The other great thing is for those again who know Loop Twist also has apple watch compatibility. So from a bolusing standpoint and everything like who always wants to pull their phone or their device out right when you got it on your wrist? I don't. I also use Trio had been a looper for a long time. I never used the watch feature because it's just me and I don't really care.

[A]

I don't care what people think I'm doing. But for people to do, big deal. And for kids in school, I've heard, you know, a lot of kids don't want to pull their phones out in class so they won't bolus because they're embarrassed. Happens a lot. Yeah. You know, you brought up people who like DIY algorithms. And I. I'm going to mention this here because I really don't know where else to talk about it. I didn't realize this was going to happen, but I was just able to give juiceboxdocs.com a really big facelift upgrade to the way it works. So if you don't know, people who listen to the podcast will reach out and say, hey, listen, I've got a doctor, an endocrinologist, a nurse practitioner. They're really great. And, you know, and we started keeping a list. There's like 160 doctors on that list now. Anyway, before, it used to be this just mess of, like, text that you had to scroll through, but now it's searchable and it's. It's very simple to use. I'm on it right now. Like, Jenny lives in Wisconsin. If I type in, even just wis, I'm already there, and it gives me back two returns in Wisconsin. I'll just say them for fun.

[B]

Are they in my area?

[A]

Well, let's see. It's Paola Sisto. It looks like Paola is pediatric at Children's Hospital Nenya. N E, E. N A Y. Nah. Wisconsin. You know where that is? Jenny's like, I know where it is. It's up the street. I just don't know how to say it. What is the. How do you say it?

[B]

What is it? N E. What?

[A]

N E, E, N, A, H. Nina. Nina. Sorry. All right. But anyway, like, the way it's set up now, what you have is her name, what kind of a doctor she is, where she works, and then there's little badges at the top. Pediatric for her. Could be adult, could be both. And also, if they're DIY algorithm friendly, it's a little badge, too.

[B]

That's awesome.

[A]

Yeah, yeah. And then you can click address to get a map, you can click the phone number to call, or you can click a link to open up their website. We're updating it now. So, anyway, juiceboxdocs.com. yeah, and so if you're looking for somebody who's DIY friendly, you can literally type in DIY and your state and you'll get a list.

[B]

That's awesome. And, you know, the doctors who are more DIY friendly would also be the ones who just in general, even if you're not looking for that, it does Give a visual. And I think this is another positive note to make. It's like finding somebody who is out of the box thinker. That's what I think. When I see somebody marked as DIY friendly or willing to work with, you know, loop or willing to do this kind of thing, they're just thinking outside the box. They're thinking in the terms of, this person needs individualization. They haven't found it here. I have to be able to help them. And then. And that's super awesome.

[A]

The list started years ago as a list of doctors who wouldn't laugh at you if you went in and said, hey, I listened to a podcast and this is what I figured out. That is really where it started. So. But it's grown since then and through the magic of AI coding, because I don't understand. I don't. I'm not a coder. I don't know how to do it. I was able to. I should thank people real quick. Monica and Isabel, who helped me on Facebook, they took all the data from that website and put it into a Google sheet, basically, so that the code could pull from it and populate and be searchable and everything. And that's awesome. And I. I vibe coded the search bar and I don't know, like, the world's opening up, like. So anyway, I was able to make the. Make it a little better. Okay, so that's something you were excited about. Twist. What's something you're angry about?

[B]

Oh, the checklist.

[A]

The checklist? What do you mean?

[B]

There's, like, multiples. Like, there's a whole checklist of things.

[A]

Oh, I thought you meant the checklist. But you're. You have a checklist of things you're angry about?

[B]

No, there are checklists of. Of things that would be lovely if they could be solved. Let's see. What's one of them? Well, I think as we're just talking about some positives, like with Twist, I think it's that if there weren't halting factors in getting adjustments to our technology, the way that technology moves in terms of updates for what the diabetes community wants, it's slow. Yeah, it's slow. I mean, that is a common thread of commentary across the board. When is this coming? Why is it not coming out? And as a rational thinker, you can say, I understand, I understand. Like, the things that need the red tape, right? All the stuff that has to get done in order for it to be safe, to put on the market. Proven safe doesn't give you blue dots across your face. Or whatever it is. But when you're the person living with diabetes and you see what's there. And then now we have like years ago as a kid, there was no comparison. You got what you got, right? There was no online community, there wasn't the DIY community. I think that's the biggest piece that puts this in people's mind as what? Why can't you move faster and make changes? There are these people that most of them aren't even getting paid.

[A]

Handful of people spread out across the map who are volunteering their time and either writing big chunks of code or small bits or helping like, you know, QC stuff and, or write, you know, write out documentation so that you can understand what you're looking at and look how quickly it moved.

[B]

Right?

[A]

Yeah.

[B]

And it's the behind the scenes. Then it's my question, like a product comes out and I think, was anybody with diabetes on this board of configuration, like, who, who thought this was a good idea? I just don't like, these are the things that bother me when people come to me with questions. I'm like, I don't know. I don't know who was behind it. It was like, I don't know. I really don't leave people who, who, who dreamed this up.

[A]

I have a friend when we were younger would say, I think every company should have somebody with a slightly twisted mind in every meeting. And, and I said, why? He goes, have you ever read some of these greeting cards and stuff? He's like, they're very dirty, but I don't think they mean to be. And he's like, they needed, because they needed me in there to go, well, I don't think we could say it that way. And, and I think very similar to what you're saying is you need somebody with diabetes in the room to go like, have you considered this part of this? Because. Yeah, right. When you get like well intended, business minded people in a room who don't know diabetes or even aren't free to speak up. Do you have any idea? I just got a recording set up with a company and they said, who do you want to have on? And I said, somebody who understands this and isn't worried about what your lawyers think 100%. Can I get that person, please? I'd like to speak to that person. And you can, by the way, anytime you say that on a call, now that we all got Covid and we have Zoom now you can see people and they all make the face, the I know what you mean face. I know that we send people out who just blah blah blah, talk in circles around stuff and won't say anything. You know, I want somebody with some autonomy. Like right? If they can't answer the question for real, then what's the point of all this really? Today's episode is sponsored by a long term CGM that's going to help you to stay on top of your glucose readings. The Eversense 365. I'm talking of course, about the world's first and only CGM that lasts for one year. One year, one CGM. Are you tired of those other CGMs? The ones that give you all those problems that you didn't expect? Knocking them off, false alerts not lasting as long as they're supposed to. If you're tired of those constant frustrations, use my link eversensecgm.com juicebox to learn more about the Eversense 365. Some of you may be able to experience the Eversense 365 for as low as $199 for a full year at at my link you'll find those details and can learn about eligibility. Eversensecgm.com juicebox check it out. I used to hate ordering my daughter's diabetes supplies. I never had a good experience and it was frustrating. But it hasn't been that way for a while. Actually for about three years now because that's how long we've been using usmed usmed.com juicebox or call 888-721-1514. US Med is the number one distributor for Freestyle Libre systems nationwide. They are the number one specialty distributor for Omnipod Dash, the number one fastest growing tandem distributor nationwide. The number one rated distributor in Dexcom customer satisfaction surveys, they have served over 1 million people with diabetes since 1996 and they always provide 90 days worth of supplies and fast and free shipping. USMED carries everything from insulin pumps and diabetes testing supplies to the latest CGMs like the Libre 3 and Dexcom G7. They accept Medicare nationwide and over 800 private insurers. Find out why USMED has an A rating with a Better business [e-mail] sl juicebox or just call them at 888-721-1514. Get started right now and you'll be getting your supplies the same way we do, correct? Yeah.

[B]

What was the purpose of the business meeting and bringing in the donuts that probably cost $300 and the right what was the purpose?

[A]

We didn't get anything done and there's Always somebody in the back who has a look on their face, who, you know, has the right answer. And they're like, I ain't saying. And I was like, I can't tell you.

[B]

I have the answer, but I can't tell you. Well, it makes me also think of. I in the past have gone to, like, market research, types of, you know, where you get to try a product, you get to play with it, you get to make the comments. Where do all those comments from people with diabetes go? I guarantee I've often felt like they just were like, thank you for your time. Here's your Starbucks gift card for joining in our services. And then they throw it in the tray because nothing that. That I have ever commented on. And I feel like in the diabetes world, like, I have a brain.

[A]

Right. It might be worth listening to for a second.

[B]

It might be worth listening to. Where did my information go?

[A]

I, along with countless other people. I'm not taking credit for this, obviously, but I don't know how many times I could have said to Dexcom over the years, can you please, like, add a delta to the feedback? I want to see how far the blood sugar moves since the last reading. Just show me plus three, minus four. Can I just. I mean, that coming. Listen, I obviously don't know, but I did just go up to an AI input and say, I want to write code that makes this sheet searchable. And I wanted to do this, this, this, and this. And then it didn't do it quite right. And I was like, no, do it more like this. Do it like this. Make a badge. And like, two days later it was done and I'm an idiot. So, like, you can't show me delta. And so is it that you can't. Like, is it that you tried and it messed. It broke something. Because if that happened, like, fine, you know, I don't want it then. But is it because you didn't have enough people or you didn't think it was important or, like, because the whole community wants that thing to show Delta 100%?

[B]

It's the reason that it's in the DIY stuff. Yeah, it's the reason I can see on my. Oh, gosh, I'm. I've risen four points in this amount of time. Right. If it's on that, it's clearly possible and it's not rocket science.

[A]

Yeah, right, Right. And it also helps you now, like, now that G7 reports, I think seems like it reports differently than G6 did, because I now see more like, you know, and maybe it's more. I don't know if it's. I'm just saying it does it differently. Like, if Arden jumps in the shower and I see like a plus 12 out of nowhere, now, I know I don't think it's going to stick there, and I think it's going to drop again. It's not a thing to worry about. But if I just looked up and saw the number, I'd be like, ooh, I don't know what that. That number looks high to me. But. And I'm speaking because I use sugar pixel. I have a sugar pixel at my house. Right, Right. So, like, I look over and I see suddenly the sugar pixel looks out of whack. I go, that doesn't make sense. And now. But I know it doesn't make sense because of the delta. Not be. Because if it was just the number, I would just think it was the number. Right. So anyway, that's an example of what Jenny's talking about. Like, that can't be hard to do. And if it is, then I fundamentally don't understand and that's fine. But, like, it just feels like it can't be. So.

[B]

Right.

[A]

And I have probably interviewed somebody from Dexcom dozens of times in my life, and I have tried in earnest to mention it every single time. Please, can you add delta? People are asking for Delta. Could you add Delta? And they go, yeah, it's on the list. It's on the list. The list.

[B]

What list? See, I've got a checklist. Like, why do these. Really? You've got a list, it's on the list.

[A]

Help me out.

[B]

Do you have 700 other things on

[A]

the list that are better be world peace, you know, Correct. Anyway, and by the way, Dexcom is a longtime sponsor. I love Dexcom, dexcom.com juicebox to learn more.

[B]

They are. I have also been a Dexcom customer for a very long time, by all means. But I think we all have complaints. Despite loving the fact that there are products and there are opportunities, I should say options to choose these days, comparative to years ago where there were not options. It's lovely, but with the technology we have today and what year again, did we put somebody on the moon, Scott?

[A]

I think it was in the 60s, wasn't it?

[B]

See, my point being, if we've done that, which is rocket science, to my baseline understanding why this should be doable with the technology we have today, is it not just quick fix doable?

[A]

Why can one pump company seems like they can more aggressively update their algorithm than another one like, is that backrooms problems? Is that. Do you not. Are you. Is one company better at talking to the FDA than the other one? Do they have different coders? Are they like. I don't know what it is but like it's obvious from our perspective that, you know, some people look like they're running forward and some people look like they're not and it gets frustrating when you're not so. This episode is sponsored by Tandem Diabetes Care. And today I'm going to tell you about Tandem's newest pump and algorithm. The Tandem mobi system with control IQ/ technology features Auto bolus which can cover missed meal boluses and help prevent hyperglycemia. It has a dedicated sleep activity setting and is controlled from your personal iPhone. Tandem will help you to check your benefits today through my link tandemdiabetes.com juicebox this is going to help you to get started with Tandem's smallest pump yet that's powered by its best algorithm ever. Control IQ technology helps to keep blood sugars in range by predicting glucose levels 30 minutes ahead and it adjusts insulin accordingly. You can wear the Tandem Mobi in a number of ways. Wear it on body with a patch like adhesive sleeve that is sold separately. Clip it discreetly to your clothing or slip it into your pocket Head now to my link tandem diabetes.com juicebox to check out your benefits and get started today.

[B]

Well, that brings up another one.

[A]

Yeah. Oh no.

[B]

I can talk for a long time. No, this one is along the same lines. It's essentially and this came mostly a couple years ago when Omnipod 5 came out. I call out the fact that when you get a new phone or your controller dies, you have no backup to your algorithm.

[A]

Yeah. Why isn't that backed up somewhere? What? Yeah. What the. You just going to make me start over again?

[B]

Are you kidding me? And I understand that there are tricks and things. Why should we we live this 24 7. Why should we have to play darn tricks to get it to update and get to where we had been once we finally finagled the system to get our blood sugars where we wanted them to be now somebody ran over my phone, right? Great. So now I have to re finagle the system.

[A]

Yeah.

[B]

And figure it out again.

[A]

That is a completely fair. And I'll tell you what too, again. Omnipod, my longest sponsor.

[B]

I know.

[A]

I just did social media for them last week. I just went to Massachusetts and made social media for them. You'll see it eventually. I think it's a Fantastic product. But what a great example you gave us a pump that, like, makes adjustments to insulin and then if I drop my phone in the toilet, they're all gone.

[B]

Right.

[A]

Have you heard of the Internet? Do you know what the cloud is? Can it not be backed up? And that's the thing. It's the thing that I think most people just live with it. I'm sure most people don't even know. Right. Like, maybe their phone will never break and it'll never be a problem. And once. And if it is, it's probably not that big of a deal to take care of, but it also can't be that big of a deal to handle. Just back the settings up. Is that not like, you know.

[B]

And I will fairly say that it's the same thing with Medtronic.

[A]

Okay, so.

[B]

Right. I mean, because they're both, in a way, similar adaptive algorithms. Right. So in terms of I have to get a new pump. Well, great. Now all of that adapting has to start over. It. It does.

[A]

I can easily argue the other side of this. There's probably a cost involved. They're now taking responsibility for accurately backing up your settings. It's probably a HIPAA thing. Right. You probably have like. Because you can't just. I. I know, but can I legally take your settings and put them with your name on a. On a computer then? What if that gets hacked and now

[B]

there's a ID number?

[A]

Yeah, you could do that. Right.

[B]

Like, come on.

[A]

Again, I was just trying to argue the other side.

[B]

I know you're trying to be very kind and very fair, but I also. That's why I said it's not just. It's in general the way that these adaptive algorithms to the two systems that we do have, it's the way that they're designed to work. So redesign it. There is no reason that what the system has adapted to doing can't live someplace with your ID number, a 6942 instead of your name. And then it gets, oh, gosh, identify. And I dump it back in and whoop, I'm all up and running again.

[A]

Come on. I'm not saying that. You're not. Right. Yeah. So everybody could be doing. And it's funny. I just had. I'm allowed. Am I allowed to say this? I just signed it. I just signed an NDA. What did it say? Hold on a second. I can say this.

[B]

Okay.

[A]

I'm going to be involved in, like, an advisory council thing for Dexcom. Actually, I'm doing it later today. I'm going to spend Three hours on a call today. And I know three hours.

[B]

They want some advisory. I give them some advisory.

[A]

They're paying people their time. Hey, feel free to send over your thoughts. I'll funnel them right in. Don't you worry. I'm not doing it for the money. It's a fair. It's a fair coverage. It's not. It's not all the money in the world. It's a lot of time. But I. It'll be a nice little check when it's over. Not going to change my life. I'm not off to the Maldives after this. No, but I thought it was a good. A good opportunity for me to funnel what people that I hear talking about back to them. Not just because if I funnel back what I see. What I see is Dexcom G7 lasts 10 days plus hours for us. It's accurate. I feel very safe on it. It jives well with her body chemistry. But I also know plenty of people who have know, reasons, issues. So what I said to them was, I'll do this if. When you ask me. Because they asked me to kind of like send in my thoughts ahead of time on the device. I said, but when I do it, you have to let me send everybody else's thoughts too. And they were like, okay. So I actually have a. A post up now that's collecting people's complaints, basically. It's like up to like 250 comments. And so I told them.

[B]

The other people have checklists too.

[A]

Yeah, yeah, those. Well, one lady had like. It's like, look like a letter she had written before. She's like, just take this. And I was like, okay. But to their credit, they wanted that, right? They were like, yeah, send it. We'd love to see that. And I was like, okay, great. Now hopefully, like you said, they'll do something with it and not just go, oh, that's crazy, and then throw it away.

[B]

Right.

[A]

But it's part of the thing that I filled out in the beginning when they asked me about what I think about the Dexcom product. I said it's a kind of an unfair thing to ask me what I think about cgm, because I've talked to thousands of people who've lived with diabetes and insulin before cgm. And I know that if you put me in power, I'd slap one of those things on everybody who uses Insulin. Right. Any of its shortcomings, I don't care about, I hope you fix them. And you should. And I think maybe you should be going a little faster with some of it. But like, but having said that, way better than not having it.

[B]

And 100% yes.

[A]

And that's how I feel about it. And I said, but I have the perspective of having spoken to a 70 year old guy who boiled his urine at some point in his life. So I know the value of it. A person who was diagnosed last week who got told the thing lasts 10 days and they can't get it to go past seven days. And then you tell them oh, don't worry now it's going to go 15 days. I go oh, what's the difference if it says 10 or 15? If I can only get to 7, is that going to get fixed? Is that a limitation between the, the device and my body? Like I need to understand a little better.

[B]

Right?

[A]

Yeah, I've been very clear and honest

[B]

and, and I think that's a fair point that you just made too. Right. The, the device. More to the side of the device companies, they are trying their best to serve the greater population. Right? They really are. And that's, there's huge value in that because again years ago we had virtually nothing. Right. But the bigger piece to that being with cgms, we all have under skin differences and it's very visible when you look at who can utilize one sensor versus not another sensor. And even within one family. I have a family I work with with two little kids, both young. One of them can wear the Libre 3 with phenomenal results. Put a Dexcom on that child and it is all over the place. The other child absolutely does beautifully with the G7. Phenomenal. They're in the same family, they're 100% gene related. Right.

[A]

And I've tried to make this point when I've interviewed companies in the past. You're asking them to make a mechanical device that, that goes under your skin and works exactly the same way from person to person to person. It's not going to, never going to work that way. Yeah, it's. And it is phenomenal how well it works now when you're asking for criticism, it gets funny when people are like oh this happens to me all the time or that. But we don't talk about it the other way. Which is for a mass amount of people it works great and it's saving people like it really is in, in a, in a multitude of different ways. Yeah, I told them, I said I think my daughter is healthier, safer, happier, less encumbered. All because of DexCom.

[B]

Absolutely.

[A]

100% Do I wish that I wouldn't like have her turn to me a couple times a year and go, what happened here? The wire popped out of the top when I was trying to put it in. Yeah. I'd like for that not to happen. Right, yeah. Also, it's happened. I don't. Three times in the last four years. So, like, I don't know, like, thank you is usually what I end up with. I usually end up with thank you. But if you're looking for shit to improve, here's my list. And I think that's what it is, really.

[B]

And I think that that also goes into another. I feel like I have a vision of both sides. I'm in the general population of people who still uses G6. G6 has always worked for me. It's lovely knowing how well it works and I have coverage for it. I didn't switch to the G7 because I work with enough people, as you just commented, have enough issues that I was like, why would I switch when something works? Right. So now we know that it's not going to be available anymore. So I like hoarding, stockpiling as much as I possibly can, as I'm sure many people are if they possibly can. But I also see it from the other side. You know, our question in the diabetes population is, why can't you just keep making both? Right. Why can't you just keep making the G6 and the G7? 100%. That was my initial thought. Like, what are you doing? You're getting rid of something that works for so many people, but on the opposite of that, there's only so much energy in a company that can go into continuing to build better.

[A]

Yeah. Right.

[B]

And so when you have a product that's been out for a long time. Yes. It's. It's well liked. It works really nicely. What I think they should do is marry what was working and what isn't working and into improving next and then getting rid of a product so that they can focus on building into the next generations. Right. So I see it too, from a company standpoint of energy going forward. We're trying to fix problems. But you people still want G6.

[A]

Right.

[B]

And so there's. There's a lot there.

[A]

Maybe what we don't know is that G9 is going to be amazing. Like, do you know what I mean? Like, and that it's iterative. I can't give 15% of my workforce over to G6. I need them working on G8. Seven works well. Everybody get on seven. That's the different form factor. We're going to work on 8. I got a small handful of people working on 9. And like, if you want to move forward, this is what progress looks like. And it can't be perfect the whole way. In any other world, except your health, people would go, that makes sense, correct?

[B]

Absolutely. I mean, in terms of like, like if you take a car, right. If you're not going to continue building the 1975 something something, when today we have these wonderful souped up other things, hybrid, blah, blah, blahs, where are you going to put energy into it? But when it comes to, as you just said, health, there's a very big difference because it hits you in a place that affects a lot more than just whether or not you drive in an old car to the grocery store or a brand new one. Right. There's a very different feeling. And I mean, I'm 100% in both piles. I want to keep my G6. I like it. I don't have issues with it. It works lovely for me. It works with my system. I don't have a glitchy looking system that does things all over the place. But I get it on the other way, too.

[A]

And you're going to be okay, too. That's the thing that I've learned over time, is that Arden's had diabetes for, you know, a fair amount of time now, and it has always gotten better. Like. Right. And I have felt at times like I was going backwards. But the truth is, in hindsight, I, you know, it was two steps forward, one step back. Two steps forward, we're farther ahead than we were when we stopped. Like, it might not be apples to apples. Imagine if back then I was yelling it at the wind and I was like, I like the meter we have. Don't change it. You know, then you don't get a cgm. Right? Yeah. I think your point's really well taken. There's only a certain amount of people in there. And I do think people get caught up in simplicity.

[B]

Yes.

[A]

This is going to sound like I'm apologizing for people. I definitely am not. But I see this argument a lot online. They'll tout how much money that Dexcom has in the bank because they're a publicly traded company. So they say, this is the money we have on hand. Right. And they go, you have all that money, you can't do this. There's a lot more to it than you than. I'm not a great business mind. But you're paying, I think you're paying shareholders, you're paying employees, you're keeping business running you're, you know, there's a lot happening.

[B]

There is.

[A]

I always end up saying the same thing. Thank God. Omnipod, Medtronic, Dexcom Libre Twist. Any of these people, thank God they're doing this stuff because if they weren't, you'd, you know, you'd get what you get and that would be it. Correct? Yeah. A lot of these pharma companies that used to have pumps wake up one day and decide they don't want to make pumps anymore and they're gone. Where's your, what's that one? The ping. Where'd that go?

[B]

The Animus. Yeah, that was a good one, actually. The one that a lot of people really loved and they used them until they were done and broken. Well past it was the Cosmo, the Deltec Cosmo. That one was a phenomenal pump that any listeners who were, who are old enough to have had it, they will say, I loved my Deltec.

[A]

Well, here's the part you weren't thinking about. Whoever made that needed to make money so that they could keep making the Deltec Cosmo. And apparently that didn't work out so well. So.

[B]

Yeah, yeah, yeah.

[A]

I say, I think you need a, a community focus with a business minded engine. You know what I mean? Like, you got to keep it going. So.

[B]

Okay, well, that's 100%. That's why I said like in the initial stages of product and technology kind of development, you really do still have to. And 100% should be going to the diabetes community and you should be asking what is working to begin with? What are the pros of all of these things and what isn't working? But why isn't it working? What, what's the cumbersome part? What's the pain in the butt part? What, you know what, what isn't working? I mean, now companies have even like Medtronic has their seven day infusion set. Right. Which is lovely. And a lot of. Just talked to somebody yesterday who that's the reason her daughter chose Medtronic. They're fairly newly diagnosed. And I was like, wow, you chose Medtronic? And she said, we chose it because my daughter didn't want to change that infusion set so often.

[A]

Okay.

[B]

We can change it every seven days. She's like, she doesn't care about the tubing. She's like, she wears the brick pump in a little carrying pouch. And she's like, outside of that, she likes it because that's a piece that her daughter really liked.

[A]

Medtronicdiabetes.com juicebox head over. There you go. Thank you. There's almost no company you're going to mention that I don't have a link for.

[B]

I could do all your little ads.

[A]

I just want to say that right now. Where you at, Libre? Come on, let's go. All right, what else? So there's something that you were excited about, something that you're bothered by. What makes you hopeful?

[B]

I think what makes me hopeful is the movement. While we haven't seen anything that is yet to be out of studies, it's the idea of a lot of the therapy therapies. I guess not really the right word, but like stem cell, that whole kind of like encapsulated betas that we could have implanted. I mean, hey, despite not wanting something sitting under my skin, if something was like a yearly surgical like re up of it meant that I didn't have to have all the gadgets and the beeping and all of the stuff. Heck, I'd be like in line because that would be pretty wonderful. So I have hope for a lot of those types of things.

[A]

How do you stay hopeful for that when I'm already aware that we've been talking about encapsulation for like 15 for a long time. Yeah, yeah. How does that make you. Because is it.

[B]

I think I'm hopeful because coming from. I mean, I've had type one now for 37 and a half years.

[A]

Wow.

[B]

Right. A little longer than that. I also had the original. Oh, in five to seven years. Five to seven years, it's going to be cured. But that whole idea has now changed into. Yeah, they're still working on that piece of it. I think they've got a better understanding that because we do have such an individual nature within each of our bodies and there is no proven reason, they haven't found the true reason that type one gets going to begin with. So to fix a problem, you have to have. You have to have the reason for the problem. Right. And because there are a myriad number of issues that could be the reason somebody ended up having type one, then you have to fix like a million problems. Yeah, but my so. So cure. I'm not.

[A]

Big word.

[B]

I don't want to say that I'm not hopeful for a cure, but in what I've lived through, I'm more hopeful for therapies that are going to actually navigate an issue that can't technically be solved, but there's an outside way to manage it, which was why I was so excited about the DIY kind of stuff to begin with, because that was hopeful. It was like, gosh, look, it's, it's like getting easier, I guess. And diabetes. Easy isn't a word that we use in diabetes, but it's getting easier to navigate life because of the things that are helpful in living it day to day. And so my hope is that some of these things that they're discovering with implantables and cells and not having you having to use immunosuppressive medication in order for them to work, things are also moving faster than they ever did before in that line.

[A]

So I have a couple of thoughts. So the first thing is that I don't know that they're going to cure type 1 diabetes. By solely focusing on type 1 diabetes. I almost feel like it's going to be more about the immune system and the immune response. Right. Because I watch my daughter's life or even people adjacent to me. My son has Hashimoto's, for example. Like, you see where their, their, like physical struggles are. It's all like inflammation. And yeah, it just like that to me is. I don't know if, I don't know if we're ever going to figure that out as a species or not. But, like, that's the core of the problem. I think you unlock that. It probably, I think you turn that one lock, it probably opens a lot of doors.

[B]

Right.

[A]

I am mostly hopeful that, honestly, that AI is going to help researchers move more quickly. That's kind of where my head is on that because I think asking one person to dedicate their life to something, they get 40 years into it and realize, oh, God, I picked the wrong path. Like, I proved it wrong, but I'm done. I die like, I'm retiring and like, I didn't come up with anything except for, don't worry about this, guys.

[B]

Prove that this isn't the avenue.

[A]

What a way to live your life. And by the way, thank you to those people. But. Right. Maybe we can pull together all those ideas and have, you know, a whiteboard. I found myself talking about this the other day too. And I do think it's another way people with diabetes are going to be helped in the short term. And, and that's. Remind me, if I don't go back to short term, remind me to go back to it. But, okay, I've had a number of situations now where I've just sat people down in front of like an, in an LLM and I was like, just explain all your problems to it because it can keep it in its head, unlike a doctor, can't Jenny can't, like, you know, you. You help a lot of people. You don't jump on every, you know, with the next client and go like, oh, I remember everything about you.

[B]

Right.

[A]

Having a place where all of your information is centralized and available to something that can consider it all and can see the Internet and the ideas around health at the same time and maybe draw lines for you. That's all. I think that might be a really big deal. But short term, I find myself talking a lot to people about wasted time. You know, not to be too, like, hippie dippy, but I find that to be the greatest sin is to waste time. Life is just too short to be giving time away for things. And I've had so many conversations with people who will look up and say, I can't believe no one. I've had diabetes for 10 years. No one told me to pre bolus. Like, my life has gotten so much better in the last six months. And then the next thing they feel is the sense of lost time. And so when you're promising something to people that, you know, might not be for 10, 20 years, that is very debilitating to give them something, anything, today and tomorrow, in six months from now and another year from now. I think it. It fills people's souls, like, to, you know, like, you should be out there as a company saying, we love our algorithm, but we think it can be better. You should know we're working on that right now.

[B]

Right.

[A]

You know, like, I. I don't have a timeline for you, but it is our goal to make this thing be even more valuable for you.

[B]

Right. Well, and I think to define that, too, a little bit better. I understand that companies don't want to really disclose all their little secrets because, you know, another company, but I do think that from the greater. From the greater population of people with diabetes, the company ideas for where they're moving their technology, there should be more outreach panels to ask, hey, we're thinking about this in terms of it could do this better or it could manage this better. What do you think about this? Or what are your ideas? Right. And I think they need to reach out more to the community to bring that in.

[A]

Yeah, well, get people's real experiences about how this works or doesn't work for them or what they could do better.

[B]

Right.

[A]

And collate the whole thing. Listen, I did it with people's struggles. I made a comprehensive list of the things people said they struggled with. And a lot of what you hear in the podcast is predicated on what people need to hear, because they told me where they're struggling, like that should be. And also, listen, if all these companies don't have a complete understanding about how all the other algorithms work by now, like, shame on them, I guess. You know, I. I once saw a truck full of evs on a way. They were on the way to another EV company. So the one EV company bought every one of the cars from the other EV company, and they were bringing it in to rip them apart to see how they worked. Like.

[B]

Sure. Right.

[A]

I mean, I assume that's how. That if you're not doing that, like. Okay.

[B]

And you're not doing something that you should be doing. Yeah.

[A]

Jenny, here's an uplifting little thing.

[B]

Okay.

[A]

Next April. April 2027, do you know how long we will have known each other for?

[B]

I would venture to estimate 12 years.

[A]

10. We are going to have known each other for 10 years. That's the first time you were on the podcast. April 2017.

[B]

Okay. I was trying to estimate based on my younger son's.

[A]

Oh, okay.

[B]

Birth. Because he was born in 2017, and I couldn't remember if it was that we had started then.

[A]

Or wait, maybe, am I wrong? Have we known each other longer than that?

[B]

So it could be. He was. He would have just been born. He would have been pretty young.

[A]

Wait, you're right. We met in 2015. You were on episode 37 of the podcast, November seven. Oh, so. So November 2025. We knew each other for 10 years already. Okay, how about. You know what hit me? I didn't even know I was right. You were right. Congratulations. First of all, my wife had said that. I have to now tell you that I was wrong. I don't know. I think I've just been really married a long time. She's, Whatever, trying to make sure I know I'm not right about things. The reason it hit me so hard is because you were like, you know, I've had diabetes for over 37 years. And I thought, oh, I've been making bumpers for you for so long that I've said, jenny Smith, you know, a certified diabetes educator who's had type 1 diabetes for over 35 years. For over 30. I realize I've said, like, almost all those little, like, numbers along the way. And when you said 37, you even shocked me, and it made me feel like, oh, I haven't updated Jenny's bumpers in a long time. There, you did it. Yeah, no, now I'm. Now I'm more aware of it. That's really crazy.

[B]

No, that's awesome. I know. I was actually thinking the other day, usually now during the school year, like, the boys are always at school when we do our, you know, discussions here, but sometimes they're at home.

[A]

Home.

[B]

And when they were home, like two Fridays ago, I don't think that we were recording at that.

[A]

Yeah. You needed to, like, take a day off or something.

[B]

Yeah. So anyway, it's just kind of funny. I was like, I. I look forward to all of these. And I was thinking the same thing. I was like, we've been talking together for a really long time.

[A]

Yeah, I know. I, I do. You feel like so I can. Obviously. I mean, I think it's fairly obvious for people listening, but, like, I feel like our conversations have helped me a lot over the years, like, just get a greater understanding. Have I brought any of that to you? Or do you mostly walk away going, oh, this freaking idiot. Like, how does it.

[B]

Oh, my God.

[A]

No, I guess what I'm saying is it's fairly obvious that you have a lot of education and experience that I would draw from, but I'm wondering, like, is there anything I've given you in return?

[B]

I think it's valuable, 100%.

[A]

But how. I don't understand how.

[B]

Absolutely. I think the value is in talking through something. Like, I'm very used to talking to other clinicians who think very similar to me, but it's different than talking to somebody who gets it on a similar enough level, but has. And I say this in a nice way, like a school kid way of considering describing it, and that's it.

[A]

A nice way. You're like a child. No.

[B]

And that, that's why I said I'm not. It's not negative. It's actually, it's actually a. A positive. It's a plus to you because the descriptive way that you can explain something that I've said in maybe more of a clinical way, it also absolutely helps me talk through some things in a different manner with people. It's still the concept that I understood, but I have more of like, you know, again, we educate under, like, sixth grade level, or that's kind of how we go through things until we get a base for how people understand and grab and learn. But it's that that has definitely helped. And then just like being part of your. I say you're the whole community. Right. Because you're really the one that started a really large group of people to come together, for the most part, a really friendly way of discussing and helping people. And I think there is A gigantic value. There's not a salesy component to the connections. And so. Yeah, no, absolutely. Being connected to your community is fantastic. And being able to do all of these. I. As I've told you many times before, if there's anything that I get out of it, it's the fact that the knowledge that I have, I just want more people to be able to have it, too, and to understand and be able to even take a snippet of something and get it. And, I mean, I don't even know how many people you have. What is it, like, 80,000 people now?

[A]

Who. The Facebook group has 80,000 in it.

[B]

There you go.

[A]

The podcast itself does about 140 to 150,000 unique devices every 30 days. Right. So crazy.

[B]

Like, I am one person.

[A]

Yeah.

[B]

I can't possibly work with all of those people. And I'm so happy for the people that have actually reached out and have said, hey, you know, I. I'd like to talk more with you. I need more help. I like how you talk about things, et cetera. Thank you so much. But I can't do that off for 150,000 people. Split myself many different ways in order to be able to do that. So it's brought a way to be able to provide and distribute that. And I was going to say something as you were talking about the EV car company. It kind of rolls into this, really. It's. Educators and endos should be doing something of the same. They should be looking at what is a successful, like, patient. Where have. Where have they gotten their information before they came to me? Right. And. Or what are successful practices doing differently? This practice, I've heard that they do a lot of people with type 1 diabetes, and, gosh, their management looks awesome. What are they doing? Like, they should be collaborating more, much like pulling apart the car and being like, well, how does it really function? Gosh, it's better. We can do this too. Like, make it better for the people that you're trying to help. And in doing that, you have to honestly be able to admit, I'm not doing everything right. You have to kind of step down and say, well, gosh, there might be a better way for this person, and maybe this source of education is better. I want them to have that.

[A]

That ability to say, I don't know, I might not know the best way, and maybe we should listen to somebody else. That's. That's hard to get people to do that. It is really difficult. Yeah. Do you know there's a company that actually rips Cars apart, breaks them down to their singular parts, and creates an instruction manual about how it was put together. So other car companies buy tear downs of cars.

[B]

Really?

[A]

Yeah. So there's a company that rips the car apart and basically reverse engineers the whole car. And then you, as another car company, might pay them 150, 200 hundreds of thousands of dollars just for the report so that you can learn how a different car company built that car. I didn't know that and I don't know that. That's not like what you're saying is that, you know, if you're a clinician in an office and everybody's failing, instead of looking at those people and going, you don't listen to me, maybe wonder what it is you're not saying to them, and then go find some people who are succeeding and ask yourself, why are they having better outcomes? Like, what can we steal from them?

[B]

What can we do better?

[A]

Honestly, I think that's, you know, that's kind of the core of why I've always tried to make the podcast more aspirational. And I end up saying this a lot, and I apologize for it, but when I started doing this, people told me, do not share how you help your daughter. Like, that's dangerous. And I was like, I think that's wrong. And I think we should be telling people how we're doing something. Not that I'm 100% right, but. So you might hear something in what I said that just like lights a fire.

[B]

It resonates.

[A]

Yeah, why not? And then at the same time, once I said that people would then come back around and argue again. They go, well, you're making people who aren't succeeding feel badly. And I was like, well, that is not my intention.

[B]

Right.

[A]

I hope what it really makes them feel like is that if this idiot's doing it, maybe I could figure it out. Like, that really is my goal. Like, I have no training in this. I don't the hell I'm doing. And so I figure some stuff. True. Oh, now I do. But, like, I figured some stuff out. Like, and I was like, here. I noticed this, like, you know, when I said the first time I realized that my daughter's blood sugar was staying under 200 and that's where her high alarm was. So I moved her high alarm to 180 and then all of a sudden I was keeping her blood sugar under 180.

[B]

Right.

[A]

That was a revelation to me. Right. Like, I'm sure that to the people at Dexcom, they were probably like, yeah, Dummy. No kidding. All right. But to me, it was a revelation. And then I was like, well, let me make it 150. What happens when I make it 130? I was like, oh, you get what you expect. Like, just. For some reason, the decisions I'm making are being made with good settings, good core ideas. And if my goal is under 150, I seem to get under 150. If my goal becomes under 130, I seem to be getting that. And I said, I hope that looks aspirational to people. I hope they think, like, maybe I could do that, too. Because if you're busy running around telling them all the time how hard this is, and I understand it sucks, and it's never going to get better than. Then it ain't never going to get better. Like, you know, you at least try. Will everybody get it? No. But isn't it better than none of them getting it? Like, is. Is sort of how I've always felt about it. Can we finish with something? I have an idea.

[B]

Of course.

[A]

Okay.

[B]

Yeah, of course.

[A]

I texted Jenny something the other day. I was baffled. Oh, I'm risking a little bit here, because, okay, these people might hear this, but I hope not. Let me find my. My text with you, because I want to. I want to say exactly what I said to you. I said, please tell me if I'm out of my mind. I think I just spoke to an endo, and I feel like I know way more about managing type 1 diabetes than this doctor does. Is that really possible, or am I a narcissist? That's what I said. But, I mean, I had a conversation with somebody who I was like, you do not even have a baseline understanding of some of these things. And that was a doctor.

[B]

That's my frustration in working with people, as well as, you know, having listened to enough episodes of your podcast to also hear that I'm not crazy in feeling kind of the same when I interact with people. It's. It's over and over too much that people aren't getting the baseline right information from the start. Right. I mean, several years ago, I actually, one that still makes me really angry is a family came to me and had been fairly newly diagnosed. And she asked me. She said, am I crazy? I asked. I asked for something the doctor told me that I should never, ever need at this point. And I was like, well, what did you ask for? Like, thinking, I don't even know what it could be. Right? Could it be she asked her doctor for her, like, very early teen daughter for Glucagon. And the doctor told her, this is a pediatric endo, told this family, you don't need glucagon.

[A]

Okay.

[B]

Told them this. So it goes right. Like your text that day made me think right back to this factor. I was like, in what world does this person first function as a doctor and two function as an endocrine doctor? For pediatric clients telling a family that they do not need. You don't need that glucagon.

[A]

Yeah. Hear that noise in the background? That's the people at Xerus Pharmaceutical banging their heads against the desk.

[B]

It is. I don't. What? I don't understand. Quite honestly, I would love if for every single insulin order that is written, I would love for a pop up message to come. No matter who prescribes the insulin, if it's the emergency department, if it's a, it's an endo, if it's a PC, I don't care if it's your podiatrist, if you're prescribing insulin, a pop up message comes in through that system that says, does the person have glucagon?

[A]

Yeah.

[B]

If not, prescribe it at it.

[A]

Yeah.

[B]

And then it's on the person. If they don't pick it up and bring it home, then nobody should have

[A]

insulin in their house. And, and not have access to glucagon. It just. And. And if you throw a thousand of them away between now and the end of your life.

[B]

Correct.

[A]

Good for you.

[B]

I have thrown many red kits away.

[A]

Yeah.

[B]

And now several jivo kits.

[A]

And Absolutely. And good for you. That's great news. But it, that doesn't mean it shouldn't be there. I mean, that is really like saying, I don't need a seatbelt, I don't have an accident. Every day. The really, you know.

[B]

Correct.

[A]

Pretty basic stuff. So.

[B]

But a doctor told them that you're not a narcissist.

[A]

I hope the people who don't like me and only hate listening appreciate that I called, I questioned narcissism so that you could yell out loud in your car, you are a narcissist. Good. I gave that to you. You're welcome. Have a good day. But seriously, like, how, how could a pediatric endo tell you you don't need glucagon? And how when I'm explaining, like simple ideas about bolusing, could an endocrinologist go, well, I don't think that's very important. And I'm like, you don't think timing the insulin is very important? Okay, what is it else you don't understand. And then, and then, as I was kind of laying out things that I thought were important, every time I said something they would like, it felt like they didn't understand the bigger part of what was being said. They only understood, like, the very basic idea of it. And it made me feel like they, their knowledge came out of a pamphlet. That is literally how it felt to me.

[B]

Their knowledge comes out of a fellowship, which is a good, you know, in order to do a specialty like endocrinology, you have to have a fellowship. Any specialty does. But their fellowship includes not just diabetes and not just type 1 diabetes. Right. Endocrinology is all of the endocrine things that could be going on. And I like the example. When I worked in the big hospital, I did in dc, the head of our department, who was a phenomenal endocrinologist, he was adamant about not doing diabetes. I am not a diabetes endocrine. I am a thyroid, that is. And he was a phenotype. People came from all over to see this man because he knew what he was doing, but he was not diabetes. And he knew that. And that is an intelligent doctor to be able to say, this is my route, this is what I'm really good at and this is what I'm going to focus on. But I can't do this for you.

[A]

I also don't understand how you can be around it for that long and not make a leap into understanding it more deeply.

[B]

Like, Correct.

[A]

Even if you just look at the Grand Round series, like, after Jenny and I made the Grand Round series, I kept interviewing doctors and clinicians for a while to add to it, right. Nader Kassim, Jessica Hutchins, Dr. Marwa. Dr. Mueller. Who else? There's that guy, John. What's his name? John Odin. Like, these, these people, they have a deep understanding of what they're doing, right? And I talked to. The other person I talked to is no smarter than they are. It just feels like they were more. They feels like these people are more interested and more like desirous of, of understanding things deeply. And I don't. It's just fascinating because as I was saying again, I don't want to be too detailed, but I was saying some pretty basic things and they look back at me like, what are you talking about?

[B]

What are you talking about?

[A]

Yeah, I was like, I said, well, what about fat? Like, how do you talk to them about bulletin for fat? She said, I, I would appreciate if you didn't bring that up while you were here. And I was like, okay, all right. I said, well, maybe you don't want me there then. Like, maybe I'm the wrong person. Right?

[B]

Well, and the right person then is going to be exactly what, what she or he is. You're just going to get more of that, which is surface level and not, not even surface level.

[A]

Count your carbs. Just count your carbs. Get them in there. Also, can you speak more to the psychosocial problems? I was like, yeah, but like, they're all fixed by understanding how to take care of their diabetes. So it's like these people here you are telling me these people have a significant amount of psychosocial issues. And I'm telling you that after 12 years of making this podcast, most of those problems come from basic misunderstandings about how to use their diabetes and the cascading effect that comes from that. And then they go, what? I'm like, okay, I don't know what to do.

[B]

There is, it's, it's a lot of, it's a lot of frustration, quite honestly, because you feel, I mean, beating your head against the wall, right, that's that old. But it is like you're not getting anywhere. You're not going to break through because either they're so closed in accepting based on what their credentials are versus yours, or they really, truly just, they don't even know where to start with what you're saying. And so why could it be possible to be correct?

[A]

I'll tell you. If you're a doctor listening to this and you think I'm out of my mind, or you think Jenny's out of her mind, you go listen to episode 506. It's with an MD. Her name's Kathleen Moltz. She's an endocrinologist who came on the podcast, spoke. I think it's, it might be like, yeah, it's like a two hour podcast. She came on to tell me that she heard the podcast was put off by it, kept listening to it, realized she was not helping her patients the way she should be, remodeled what she was doing after the stuff you and I were talking about in some of the stuff, then went to her staff and tried to tell the staff, I need you to go listen to this pro tip series. And the staff balked and came back and said, he, they're Dr. Bashing. And she said, no, they're not. We're just not doing everything we could be doing. And they're pointing it out. And like that I was, I've never really been more impressed with the person than her Coming on to not only like to admit that, you know what I mean, and I don't know everything. I'm not saying I do. And my. My knowledge does not equal your md. I'm not certainly saying it isn't. But you guys are missing. A lot of you are missing something. A lot of you are doing great, but a lot of you are missing something.

[B]

And I think it points out to how many of those doctors that you talk to, do any of them actually have type 1? So that they do actually have a lived experience that does make it better? Or do none of them and they just took it on themselves to say, I'm an endocrinologist, I better know what I'm talking about. Because you know what? There is more and more incidents of diabetes and more and more incidence of type 1 diabetes and better diagnosis and faster, sooner diagnosis. I need to keep up. Those are the doctors that you want to seek also.

[A]

You know, you. You just brought that up. I forgot to sell you. On the Juice Box Doc page, if the provider has type one, there's a badge on their name that says provider has type one. That's awesome. Yeah, I agree. Okay, well, we obviously can do this all day, so we should stop.

[B]

Thank you.

[A]

Yep. Thank you. Today's episode of the Juice Box PODC was sponsored by the new Tandem MOBI system and control IQ technology. Learn more and get started [e-mail] Juicebox check it out. The podcast episode that you just enjoyed was sponsored by Eversense CGM. They make the Eversense 365. That thing lasts a whole year. One in the insertion every year. Come on. You probably feel like I'm messing with you, but I'm not. Eversensecgm.com juicebox. A huge thanks to US Med for sponsoring this episode of the Juice box podcast. Don't forget usmed.com juicebox this is where we get our diabetes supplies from. You can as well use the Link or call 888-721-1514. Use the link or call the number, get your free benefits check so that you can start getting your diabetes supplies the way we do from usmed. Thank you so much for listening. I'll be back very soon with another episode of the Juice Box Podcast. If you're not already subscribed or following the podcast in your favorite audio app like Spotify or Apple Podcasts, please do that now. Seriously, just to hit follow or subscribe will really help the show. If you go a little further in Apple Podcasts and set it up so that it downloads all new episodes. I'll be your best friend. And if you leave a five star review, ooh, I'll probably send you a Christmas card. Would you like a Christmas card? If you're looking for community around type 1 diabetes, check out the Juice Box Podcast Private Facebook group juice box podcast type 1 diabetes but everybody is welcome. Type 1 type 2 gestational loved ones it doesn't matter to me. If you're impacted by diabetes and you're looking for support, comfort or community, check out juicebox podcast type 1 diabetes on Facebook. My Diabetes Pro Tip series is about cutting through the clutter of diabetes management to give you the straightforward, practical insights that truly make a difference. This series is all about mastering the fundamentals, whether it's the basics of insulin dosing, adjustments or everyday management strategies that will empower you to take control. I'm joined by Jenny Smith, who is a diabetes educator with over 35 years of personal experience, and we break down complex concepts into simple, actionable tips. The Diabetes Pro Tip series runs between episode 1000 and 1025 in your podcast player, or you can listen to [e-mail] by going up into the menu. If you have a podcast and you need a fantastic editor, you want Rob from Wrong Way Recording Listen. Truth be told, I'm like 20% smarter. When Rob edits me. He takes out all the, like, gaps of time and when I go and stuff like that and it just, I don't know, man. Like, I listen back and I'm like, why do I sound smarter? And then I remember because I did one smart thing. I hired [e-mail].